IR@PKUHSC  > 北京大学第三临床医学院
学科主题内科学
脂肪因子Vaspin与血液透析患者的胰岛素抵抗及外周血管疾病的相关性研究
苏凯杰
2016-11-23
导师唐子勇
专业内科学
授予单位北京大学
授予地点北京大学第三临床医学院
学位硕士
关键词Vaspin 血液透析 胰岛素抵抗 外周血管疾病
其他题名The Relationship Between Vaspin And Insulin Resistance And Peripheral Artery Disease In Maintenance Hemodialysis Patients
分类号R459.5
摘要

[目的 ] 血浆Vaspin与糖尿病患者的胰岛素抵抗相关。胰岛素抵抗普遍存在于维持性血液透析患者中,且与心管并发症相关。本研究旨在探讨浆Vaspin与维持性血液透析患者的胰岛素抵抗及外周管疾病关系。
[方法 ] 随机选取2015年12月至2016年3月期间在北京大学第三医院血液透析中心行规律血液透析治疗的患者72例,根据是否合并糖尿病将其分为血透非糖尿病组和血透糖尿病组,其中血透非糖尿病组46例,血透糖尿病组26例。对照组选取同时期北京大学第三医院的健康体检者20例。所有研究对象测量身高、体重、血压,测定血红蛋白(HGB)、血肌酐(Cr)、空腹血糖(FBG)、游离胰岛素(FINS)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、脂肪因子Vaspin。血液透析患者同时测定血浆超敏C反应蛋白(hsCRP)、甲状旁腺激素(PTH),并测量非内瘘侧的上下肢血压,计算踝臂指数(ABI)并定义ABI<0.9为外周血管疾病。所有研究对象计算胰岛素抵抗指数(HOMA-IR)。所有资料的分析采用SPSS 22.0 软件。
[结果 ]
1. 基本资料的比较:血液透析组和对照组在男女比例、收缩压、BMI、血糖(FBG)、血脂(TC、TG、LDL-C)上无显著差异(P>0.05)。血液透析组的年龄、FINS显著高于对照组(P<0.05),舒张压、HGB、eGFR、HDL-C显著低于对照组(P<0.05)。血透糖尿病组的血糖高于血透非糖尿病组(7.18±3.55 vs 4.93±1.35 )(P<0.05),两亚组其他各项指标无显著差异 。
2. 血液透析组HOMA -IR显著高于对照组 [2.44 1.38 ,4.28 )vs 1.49(1.00 ,1.89 )](P<0.05 ),血透糖尿病组HOMA-IR显著高于血透非糖尿病组[3.31 (2.35 ,5.18 )vs 2.01(1.10 ,3.72 )](P<0.05 )。
3. 血液透析组血浆Vaspin水平显著高于对照组[0.28(0.15 ,0.65 ) vs 0.07 (0.05 , 0.08 )](P<0.05),血透非糖尿病组和血透糖尿病组之间的血浆Vaspin水平无显著差异(P>0.05)。
4. 血液透析组浆Vaspin与TC、HDL-C、LDL-C正相关(r=0.244、0.292、0.277  P=0.041、0.014、0.020),与FINS、HOMA-IR显著负相关(r=-0.273、-0.313  P=0.022、0.008)。
5. 血透非糖尿病组的血浆Vaspin水平与HDL-C、LDL-C显著正相关(r=0.425、0.313  P=0.004、0.036),与FINS、HOMA-IR显著负相关(r=-0.392、-0.411  P=0.008、0.005);血透糖尿病组血浆Vaspin水平与HGB正相关(R=0.673 P<0.001),与ALB显著负相关(r=-0.427  P=0.033)。
6. 外周血管疾病组的血浆Vaspin水平显著低于非外周血管疾病组[0.16(0.06,0.27)vs 0.33(0.18,0.73)](P<0.05),HOMA-IR显著高于非外周血管疾病组[5.57(3.14,22.41)vs 2.20(1.37,3.99)](P<0.05)。Logistic单因素回归分析显示,FINS、HOMA-IR可能是外周血管疾病的影响因子。
[结论 ]
1. 无论是否合并糖尿病,血液透析患者均存在胰岛素抵抗。
2. 血液透析患者血浆Vaspin水平明显升高,且与胰岛素抵抗负相关。
3. 血透非糖尿病与血透糖尿病患者血浆Vaspin水平无显著差异。在血透非糖尿病患者中血浆Vaspin与胰岛素抵抗仍负相关,而这种相关性在血透糖尿病患者中消失。
4. 外周血管疾病患者较非外周血管疾病患者的血浆Vaspin水平降低,胰岛素抵抗水平升高。血浆Vaspin可能是外周血管疾病的保护因子。

 

英文摘要

[Objective] Vaspin was correlated to insulin resistance in diabetes. Insulin resistance existed in MHD patients and had a relationship with cardiovascular complications of MHD patients. The purpose of our study was to explore the relationship between vaspin and insulin resistance and peripheral artery disease(PAD) in MHD patients .

[Methods] We randomly included 72 cases of MHD patients who took regular hemodialysis therapy in Peking University Third Hospital from 12,2015 to 3,2016 and divided them into non-diabetic subgroup and diabetic subgroup, with 46 cases in non-diabetic subgroup and 26 cases in diabetic subgroup. 20 cases of healthy person who took physical examination in Peking University Third Hospital were recruited as health control. Height, weight and the blood pressure were measured in all objects. Hemoglobin (HGB), plasma creatine (Cr), fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglyceride(TG), High-density-lipoprotein cholesterol(HDL-C), low-density-lipoprotein cholesterol(LDL-C)and plasma vaspin were examined in all objects. In addition to these, parathyroid hormone (PTH)and high sensitive c-reative protein (hsCRP)were examined in MHD patients. At the same time, we measured the blood pressure of upper and lower limbs on the side without vessel fistula in MHD patients and calculated ABI with the formula ABI=lower limbs pressure/upper limbs pressure, we defined ABI<0.9 as PAD.Homeostasis model assessment of insulin resistance (HOMA-IR)were calculated in all objects. We used software SPSS 22.0 to analyze all data.

[Results]

1.General information comparison: There was no difference in sex ratio,systolic blood pressure,BMI,FBG,TC,TG,LDL-C between MHD patients and health control(P>0.05). MHD patients were older in age , higher in insulin level and lower in diastolic blood pressure,HGB,eGFR and HDL-C level compared with health control(P<0.05).

2.MHD group had a higher HOMA-IR than health control [2.44(1.38,4.28)vs 1.49(1.00,1.89)](P<0.05),diabetic subgroup had a higher HOMA-IR than non-diabetic subgroup[3.31(2.35,5.18)vs 2.01(1.10,3.72)](P<0.05).

3.MHD group had a higher vaspin level than health control [0.28(0.15,0.65) vs 0.07(0.05,0.08)](P<0.05)and no significant difference was observed between diabetic subgroup and diabetic subgroup in vaspin level(P>0.05).

4.In MHD patients,vaspin was positively correlated with TC,HDL-C,LDL-C(r=0.244、0.292、0.277  P=0.041、0.014、0.020)and negatively correlated with FINS,HOMA-IR (r=-0.273、-0.313  P=0.022、0.008).

5.In non-diabetic subgroup,vaspin was positively correlated with HDL-C,LDL-C(r=0.425、0.313 P=0.004、0.036)and negatively correlated with FINS,HOMA-IR (r=-0.392、-0.411  P=0.008、0.005). In diabetic subgroup,vaspin was positively correlated with HGB(r=0.673,P<0.001)and negatively correlated with ALB(r=-0.427 P=0.033).

6.PAD group had a lower vaspin level [0.16(0.06,0.27)vs 0.33(0.18,0.73)] and a higher HOMA-IR when compared with non-PAD group[5.57(3.14,22.41)vs 2.20(1.37,3.99)](P<0.05).FINS and HOMA-IR may be factors for PAD.

[Conclusion]

1.No matter with diabetes or not, MHD patients exist insulin resistance.

2.Vaspin level is elevated in MHD patients and it negatively correlates with HOMA-IR.

3.The vaspin level had no difference between diabetic and non-diabetic patients. In non-diabetic patients vaspin is still negatively correlates with HOMA-IR, however the correlation disappeared in non-diabetic patients.

4.PAD patients have a lower vaspin level and a higher insulin resistance level when compared with non-PAD patients.Elevated vaspin may be a protective factor for PAD.

 

语种中文
相关网址查看原文
文献类型学位论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/124741
专题北京大学第三临床医学院
作者单位北京大学第三临床医学院
推荐引用方式
GB/T 7714
苏凯杰. 脂肪因子Vaspin与血液透析患者的胰岛素抵抗及外周血管疾病的相关性研究[D]. 北京大学第三临床医学院. 北京大学,2016.
条目包含的文件
条目无相关文件。
个性服务
推荐该条目
保存到收藏夹
查看访问统计
导出为Endnote文件
谷歌学术
谷歌学术中相似的文章
[苏凯杰]的文章
百度学术
百度学术中相似的文章
[苏凯杰]的文章
必应学术
必应学术中相似的文章
[苏凯杰]的文章
相关权益政策
暂无数据
收藏/分享
所有评论 (0)
暂无评论
 

除非特别说明,本系统中所有内容都受版权保护,并保留所有权利。